Week 4 Lecture Tutorial, Yes it used to be week 6.

Ajouté : 2026-05-23

[00:00:01]hello welcome back this is week six from the Colorado Dental Assisting school lecture tutorial today we're going to be talking about local anesthetic nitrous oxide and medical emergencies this lecture was originally done by dr. Scott Frederick so listen you all know this is his work his masterpiece so let's move forward alright local anaesthetic you guys are going to learn in more detail today the definitions the mechanism of action technique and of course anatomy we have some awesome pictures for you so please follow along in your binder and take notes we also are going to talk about nitrous oxide the definition of nitrous oxide and of course the advantages of it what you're going to be looking for in your patient when you guys are administering it and all of the different techniques that we use medical emergencies you will learn in your lab today how to take vital you'll learn the different types of medical emergencies and we will talk about a couple tips and tricks that doctors like to use to help avoid medical emergencies which is always nice and then of course we're going to break off into groups and go into our lab definitions okay I guess I will let's go back I want you guys to remember these three definitions because it's very important in dentistry we use many different types of pain control however it's easy to get confused with the difference between general anesthesia and what we use as conscious sedation so anesthesia is our first word up here and the definition for that is the loss of all modalities of sensation which include pain and touch so general anesthesia is achieved when the patient becomes unconscious this is usually done in a hospital setting we do not use general anesthesia in the dental office a lot of times we don't need it because we don't need our patients to be unconscious for extractions or anything like that that's usually for more in-depth surgery and it would need to be done in hospital so try to remember general anesthesia is achieved when the patient becomes unconscious local anesthesia the patient remains conscious that the anesthesia is localized to one part of the body now let's talk about different types of local anesthesia we have analgesia which is a loss of pain sensation only when analgesia has been produced it is possible that the awareness of touch may still be present so what this is talking about is a localized injection to numb an area so they don't feel pain however your patient may still feel pressure a lot of times when we have patients come in for extractions and they don't want to have the IV sedation done they just want to be numbed up and have the extraction completed that's okay our first question for them is do you feel any pain and not only do you feel pain but we need you to be aware that you will feel some pressure a lot of times when we start the extraction the patient will complain and say our or have some sort of reaction and usually that's because they feel pressure we cannot take away the sensation of pressure it's only numbing the nerves so they don't feel pain to try to explain that to them when you're asking are you okay is everything okay are you feeling a sharp pain do you just feel pressure and a lot of times their answer is oh yeah it just feels like a lot of pressure let's go ahead and reassure them and educate your patient and let them know we did give you a local anesthetic injection so you shouldn't feel any pain if you do feel pain please raise your left hand and let us know sedation is a little different sedation involves the administration of a sedative to reduce anxiety and the conscious patient in addition the patient may require an injection of local anesthesia this is so important to remember a lot of times our patients will say you know what I want to go ahead and do the nitrous oxide so I don't have to get shot in my mouth well that's not true you will feel a numbing this around the gingival area when you're on nitrous oxide however the tooth is not numb and they would feel it if we were to work on it so if the patient's trying to avoid getting a shot in their mouth and they want nitrous oxide please make sure that you inform them that they will still be getting a local anesthetic injection because we want the tooth to be completely numb and it to not have a traumatic experience so sedation can also involve IV sedation a lot of times our doctors will use IV sedation when a patient has a really high anxiety or nervous system reaction or they're having some sort of oral surgery and they just don't want to be awake for it this is considered a conscious sedation so what that means is they are not fully sedated where they're completely unconscious and unable to move or respond to us do the patients remember absolutely not majority of the time they have no idea or they remember something that didn't happen like meeting a celebrity or something crazy so in IV sedation we always give them the post-op instructions before we give administer any sort of drugs and the doctor will be in the room they will be the one administering the nitrous or the IV sedation depending on what sort of sedatives that they choose to use that day it could also be volume that they are on and that would be considered a conscious sedation it does calm the patients down and reduce anxiety it also helps reduce any medical emergencies that could come up so when we have a patient under IV sedation a lot of times we can tell them open please or can you put your arm down or try to relax lay back down you know they will respond to us when we do ask them simple commands like that this is still considered a conscious sedation would we ask a patient's to make any sort of decision making on treatment or anything like that while they're under IV sedation absolutely not in fact it's important that they bring a driver with them so someone can drive them home safely and we know that you know they've gotten home and everything's okay so anytime we have IV sedation the patient needs to bring someone with them to make sure they make it home okay so if you're not quite sure about these three please give us a call ask your instructor make sure you understand the difference cool anesthetic types I do not expect you to memorize all these different types of drugs however it's just showing you Group 1 and group 2 as far as anesthetics go a lot of times our doctor will decide on the treatment plan which way to go when it comes to anesthetics we don't want it to last too long but we also don't want to have to stop our treatment and give them another injection the mechanism of action these drugs are applied locally and block nerve conduction of sensory impulses from the periphery to the central nervous system they inhibit sodium channels of the nerve membrane so what happens is when the doctor goes to give a local injection in the mouth they are going to first insert the needle into the mouth and they are going to do what's called aspirating so they're going to pull back on the needle and see if any blood comes into the car pool they want to make sure that they're not directly into a blood vessel or an artery because we don't want the basic constrictor to go directly into the bloodstream it can make the patient very nervous and make them start to breathe a little bit faster and have their heart start to race so we want to make sure that the doctor when they're giving the injection they're looking for a nerve reaction so it's important that they get to the nerve that they're trying to block what's happening is that anesthetic is causing the area to be blocked off from any sort of firing so that nerve doesn't get to fire through the sensory impulse to the nervous system telling them Alec feel pain right but I want them to feel any pain when they're in dentistry we want them to be completely numb we're going to review a couple different types of techniques when it comes to injections we did talk about these on week two however we're going to go in a little more detail today so we're talking about maxillary we have infiltration palatal posterior superior alveolar nerve block your medial superior alveolar nerve block anterior superior alveolar nerve block and the infraorbital nerve block let's review on mandibular we have inferior alveolar nerve block mental nerve block and a long buccal nerve block maxillary infiltration and infraorbital nerve block depending on where the doctor injects this needle there are two different types of blocks they can accomplish here on the maxillary so what you're looking at is a quadrant which is the right side of the maxillary jaw and you can see that each of these nerves comes down from the mint or the sorry to mental foramen up top and feeds all of our maxillary teeth some of them do branch together it's always nice when a doctor can do a nerve block and get three or four teeth at a time as opposed to infiltrating each individual tooth so depending on which one the doctor wants to do they will show you exactly where to place the topical in your lab today we will show you the difference between where exactly the topical will be going in the patient's mouth which is important right I mean that's the whole reason we're using the topical anesthetic is to numb the oral mucosa so that first initial pinch isn't so bad if we go completely up against the teeth and straight up we would consider that infiltration when the doctor comes out a little bit and tries to reach one of these branches that would be an infraorbital nerve block and they want to block two to three T's at a time your anterior superior alveolar nerve block will be just behind eight and nine where your anterior nerves come together in that branch this is a very painful injection considering there's not a lot of tissue going on here so there's really nowhere for the anesthetic to go so one thing the doctors might do is flip over their mouth mirror and apply that negative pressure on the area right before they do give the injection what you want to do is dry the oral mucosa right there really well place your topical anesthetic and put a couple two-by-twos underneath it so that way it's soaks in good to the palate and not into the tongue and everywhere else in the mouth leave it on there for at least five minutes as at a minimum because this is going to be a pretty painful injection you also want to get your suction ready because a lot of the anesthetic is going to push back there's not a lot of room for it to go and you wearing this tissue the reason we would give this type of injection will more than likely either be an extraction or if the patient has had some sort of trauma posterior superior alveolar nerve blocks we're still on the maxillary and we're looking for a posterior nerve block on the molars so you can see exactly where the doctors injection goes into the oral mucosa again make sure you dry it off really well and place that topical on there anywhere from three to five minutes our greater Palatine block is going to be in the back pallet posterior area this is going to be pretty painful as well again this is going to be either the right or the left side because of the midline will block the rest of the nerves from completely infiltrating the entire maxillary you want to make sure again that you put your topical on there for at least five minutes so it can soak in really well we have another Mandeville mandibular injection here this is called a long buccal block so the biggest difference between this one and the inferior alveolar nerve block is what it's going to affect in the mouth so once this has infiltrated we will just be numbing the posterior molars on the buccal side of the mandible you can see exactly where the injection goes into the oral mucosa and you can also see a picture there of the lower mandible then fear your alveolar nerve block otherwise known as the ia block for short is going to be in that fatty tissue in the inside lingual surface of the back of the mouth this is important that we put a good amount of topical back there as well because this one's a little bit of a zinger once they hit that ia nerve which is good because they know they're right where they need to be this will affect the entire quadrant either on the right or left side of the mandible all of the teeth the lips the tongue and the gingiva on that area so a lot of times a lot ask our patient is your lips numb because by the time it's infiltrated to the midline the lip will be completely numb and we know that the patient's ready to go till nerve block will be an anterior injection for the mandible just behind the canine when you pull the lip out as you see in this picture you'll see a little tissue attachment down there that's where you want to place your topical because for the doctors going to inject this will numb the teeth and lip area only on the interior either on the right or left side to the midline ass oxide nitrous oxide is also known as laughing gas this is going to be a mixture of our nitrous and of course our oxygen gases depending on how much nitrous the doctor wants to administer to the patient the doctor will be the one administering this drug unless you are certified to administer it you will not be in charge of administering any drugs to patients nitrous oxide is a central nervous system depressant nicer oxide is metabolized in your body and passes almost exclusively through the lungs a flow meter controls the mixture of the o2 and the n2o and employs a safety feature which shuts off the system if the oxygen tank becomes empty patients should never be left alone when administering nitrous oxide you guys need to remember this because you will be in that room with the patient the entire time you are not to leave the patient alone a scavenging system also known as the vacuum system should remove the exhaled nitrous oxide from the treatment area we are going to show you what it looks like our scavenger system in the operatories and as well the one that we have that's mobile that can move around from each operatory nitrous oxide should never be given to a pregnant patient it has increased risk for spontaneous abortion this is a little tutorial of what to expect as far as concentrations of sedation we want you to know what kind of science to look for in symptoms in patients this needs to be your top priority when you're in the room you want to make sure that the patient is safe and that the symptoms that they're having you're paying attention to and that you're there to make sure to advocate for the patient so early to ideal sedation is a concentration from 20 to 30% everyone is going to react to this differently your doctor might need to turn it up for certain patients or others they might need to turn it back down so try to keep that in mind we will take vitals for our patients anytime we give them any sort of sedation so if the patient comes in and they're getting IV sedation or let's say they're doing nitrous oxide we are going to take their vital signs and record it in the chart notes before and after while the patient is in our office for treatment the lightheadedness dizziness tingling of the hand and feet body warmth feeling a vibration throughout the body numbness of hands and feet numbness of soft tissue of the oral cavity feeling of euphoria feeling a lightness or heaviness and extremities so they're going to tell you that they feel numb in their mouth you'll notice their blood pressure heart rate is slightly elevated early in the procedure and then it will return to a baseline value their respirations should be normal so watch their respirations make sure they're not starting to breathe heavily or starting to hyperventilate they will have a vasodilation of the peripheral vision flashing of extremities in the face so they might get a little red in their cheek and you'll notice that their arms and legs relaxed their shoulders relaxed back and they're kind of like okay this is good I can do this I'm okay here when they first sit down a lot of times they're very closed off and you'll watch that body language change as the concentration from the nitrous starts to enter the body and relax the patient a heavier sedation or slight over sedation let's talk about those symptoms and signs it can be a concentration anywhere from thirty to fifty percent but again remember some patients be affected differently at 40% than others so this is just a general idea hearing especially of distant sounds becomes more acute visual images become confused they can see a pattern on the ceiling or the wall sleepiness laughing and crying we don't want them to get nauseous right I do not want to be cleaning up anyone's do guys don't think you do either so let's make sure and keep that under control their movement will increase so they're going to start to get a little antsy they don't want to sit in the chair anymore their heart rate and blood pressure will increase and of course their respirations will start to increase they might start sweating and they might cry so when you see these signs and symptoms start to arrest you want to let your doctor know what's going on please again do not leave the patient in the room by themselves so if you have a radio or if someone is near you ask for help so the doctor knows what's happening it's not very common that the doctor leaves these patients like this for long periods of time in the room by themselves with you so don't you know I don't want you to get the idea that like you're going to be in there alone a lot that's really not going to happen it might be maybe five to seven minutes while they go do an exam really quick and come right back but if you need help there will be plenty of people there to help you if for some reason some sort of medical emergency was to happen here's a picture of a scavenging system that shows you where the oxygen and the nitrous flow meter is so that way you know exactly how much is being administered you will be required to chart this so make sure that you record this into the chart note exactly how much of the nitrous was administered and then how long they were on pure oxygen before they left the office and we're feeling better record their symptoms and all of the signs that they had while being on it and that way you can give them a really good idea if they had it in the past they can't remember how they were you can always go back to that chart note and say oh you know you had a really great experience and this is how it went this is how much we administered so that way we know what's going on so this is telling you the mixture dial increases and decreases the level of analgesia by basically pushing it up or down in the amount of nitrous the flow dial going up or down the volume of the gas to the patient so that's going to show how much of this gas is actually flowing through the tube to the patient that they're breathing in the reservoir bag will inflate and deflate as the patient breathe so you want to watch out for that make sure it's connected and everything's running like it should should always be partially inflated it is not turn up the flow valve all you guys do is turn up the flow valve and it will start to inflate the o2 flush button is used at the end of the treatment to purge the system of the nitrous the mixture the dial is then set to 100% oxygen and the patient is allowed to breathe 100% oxygen for several minutes this will bring them back to consciousness and completely sober them so they are okay to drive home and go about their business the nitrous and oxygen flow meter tubes show the relative amounts of each gas being administered to the patient so again you want to pay attention to that so you can record it in the chart note here's another picture of a different type of scavenger system works the same it's just a different brand so I want you to see what that looks like remember the nitrous is a nose mask and it's placed on a patient and is then instructed to breathe in through their nose only the scavenging system should be used to remove any exhaled nitrous your nitrous will be blue and oxygen will be green so remember when you hook up the tubes to it honestly you can't hook them up incorrectly because they don't fit but the green will go in the green and the blue with the blue the advantages of matrice the administration is simple and easily monitors the great thing is they can drive themselves to their treatment that day and drive home and they are completely okay recovery is rapid within minutes after the nitrous has stopped nitrous is very safe when administered correctly and it can be used on patients of all ages the patient remains awake and is able to communicate so the great thing about nitrous that unfortunately we can't do with a local IV sedation is we can put them on oxygen for several minutes and then let them know how the treatment is going I'm sorry patient but it looks like you're going to need a root canal for this to do you want to move forward with that or would you like us to go ahead and put in a temporary filling and send you to a referral they can make a decision that day and then we can put them back on the nitrous and quickly and efficiently get the treatment done same day we don't have to have them come back in and take more time off so it definitely has its advantages medical emergencies you guys will be learning how to take vitals today with a micrometer and a stethoscope and you'll also learn how to take vitals with the electric cups that we use I want you to pay attention to the differences and you know take your time with this one I know it seems like this is going to be a really quick and fast lab and you know what are we really doing this is very important you guys it's important that you understand how to do this not only that you can hear it and listen for it but that you can read the needle while it's dropping when we're collecting the blood pressure numbers so please take your time and make sure that you don't only work on the same student today make sure you guys swap partners because everyone's going to be a little bit different so try not to stay with the same person it'll be in your best interest to have a different student for each lab blood pressure so the systolic pressure is the pressure in the artery during contraction of the ventricles your diastolic pressure is the pressure in the arteries during rest a normal blood pressure is anywhere from 120 over 80 you may or may not see this in your lab and then the uses of this manometer this is our blood pressure cuff and of course we are going to be using the stethoscope as well so you can listen for that blood flow we want you guys to be quiet during this lab and maybe you know break up into a little bigger area so that way you're not on top of each other so you can really hear that effect in the stethoscope pulse you will be learning how to take pulse when you are taking a pulse make sure you use your two fingers and not your thumb because you're going to be getting your own heartbeat if you use your thumb the pulse is measured is I'm sorry the pulse is the measurement of the heart beats per minute you're going to check on either the carotid artery which is in your neck or the radial artery in the wrist normal is between 60 to 100 per minute if you want to do if you want to go ahead and set a timer for this that would be ideal I know you guys can do it for half the time and then multiply it but I'd rather you do it old-school do it for the complete then it and see what you get respirations this is a little harder to get done I feel like a lot of times when we're doing this lab is because we're aware of the fact someone's trying to count our respiration so then we start breathing fine so my suggestion is when someone is taking your blood pressure try and count their respirations while they're paying attention to the blood pressure so that way they're not really thinking about it so your respiration is the act of breathing you're going to look to the chest to rise and fall normal is going to be around 20 respirations per minute medical emergencies angina is chest pain which is called caused by an inadequate oxygen to the heart a myocardial infarction is a heart attack this is a condition in which damage to the muscular tissue to the heart is commonly caused by obstructive circulation seizure the physical findings are changing and behavior that occur after an episode of abnormal electrical activity in the brain if a patient knows this seizures are common for them they will let you know and it will be in their health history so a lot of times if you see that in someone's health history when you seat them ask them you know how many seizures do you have a day if one happens what would you lose what are you most comfortable with us doing to help you through it so I don't want you know if you feel like you you have anxiety about it or you're going to panic please let your doctor know so that way they know the situation and maybe swap out with a different dental assistant we don't expect you you know to be able to do anything by yourself as far as medical emergencies go but it is something that happens in dentistry and we need to be aware of the situation and be proactive so that way we can help our patients if something does happen a stroke happens when blood flow to part of the brain stops also known as a brain attack if blood flow is stopped for longer than a few seconds the brain cannot get blood and oxygen so brain cells can die causing permanent damage an allergic reaction is usually an immune response or reaction to substance that are usually not harmful the symptoms you might see in a patient are swelling they might feel like a burning sensation you might see wealth or hives on them people can be allergic to just about anything and so anytime we see any sort of allergic reaction in a patient we make a note of it in their chart so whatever they came in contact with that day we make sure that you know we don't put them at risk again Laxus is a life-threatening type of allergic reaction what happens is the esophagus starts to close in the patient is having a hard time breathing we do have a crash cart in all of our offices for all of these different types of medical emergencies so something happens you'll always call on your doctor and your doctor will tell you exactly what they need you to do a diabetic attack hypoglycemia occurs when blood glucose levels fall below four millimeters per liter and symptoms we could be pale feeling weak hungry they could have a higher heart rate than normal it could have blurred vision temporary loss of consciousness so they could faint confusion they could have a seizure because of it in an extreme case you know we would have to call an ambulance in so if somebody has a diabetic attack again we do have that crash cart ready to go and it has all of our drugs and everything we need in there to help the patient if you need to call 9 on when the doctor will let you know an asthma attack is a disorder causing the Airways of the lungs to swell and narrow leading to wheezing shortness of breath test tightness and coughing if a patient has asthma you will be aware of it because it will be on their health history and again they will talk to you about it and let you know you know I have inhaler or whatever the case may be syncope is very common in dentistry so this is the medical term for fainting or passing out so it is a transit loss of consciousness it's usually a rapid onset short duration and spontaneous recovery it's due to low blood flow to the brain so what happens is our patients come in they have high anxiety right you're not really exciting to be here they might have to get some treatment done today that they are just a little freaked out about and a lot of times our patients that don't do the IV sedation and just decide to be numb we will extract the tooth on them or complete whatever treatment it is we're doing and once we tell them hey you did a great job you know we're just going to put some two-by-twos in there for a minute and let them sit and then um we're going to stitch you up I want you to stay seated because the second you tell them you did a good job they're like okay I'm done let's go let's get out of here I don't want to be here anymore and they usually get up out of the chair too quickly and we come right back down and they faint you don't want to try and catch the patient because they could take you down with them and then who's going to help the two of you if you're both down right so to avoid this situation tell your patients the treatment is complete however I need you to stay seated I'm going to go ahead and get your vitals again before you go and answer any questions you might have about post-operative treatment make sure that they stay seated it's very important we don't want the patient to accidentally get hurt in any way chest pain our doctor likes to follow this order when it comes to chest pain so nitrous oxide a lot of times the doctor is going to administer nitrous to help blood flow and get everything kind of calmed down and also oxygen oxygen is good a lot of times when patients have chest pain it could just be anxiety so if we put them on oxygen they start to breathe better and get some more oxygen into their brain they start to calm down if we have to use nitroglycerine the doctors usually prescribe nitroglycerin for angina which is often call as which is often caused by some sort of heart attack so it is a sudden heart release chest pain and it happens because something prevents the flow of the blood to the heart muscle so nitroglycerin is going to help widen the blood vessel and more blood is going to be able to get to the heart muscle and help the chest pain go away so we're hopefully avoiding a heart attack at this point with the nitroglycerin aspirin is used in patients with heart disease and it's really common so any of these four types of drugs would be administered to the patient attending the doctors evaluation let's start in the lab who's ready okay so we are not doing injections today please don't get freaked out about the picture but we are going to be placing palpable in the areas that we talked about for injections and dentistry you guys are going to practice preparing the syringe and recapping the needle if you can't remember how to recap the needle please ask your instructor to show you so you don't accidentally poke yourself if you do accidentally poked yourself hey at least it's a clean needle right we haven't worked on any patients today please dispose of it in the sharps container immediately and let your instructor know and of course we are going to be taking vitals we want to show you guys the AED and emergency kit in our crash cart so that way you know where everything is if for some reason we would need to use it in class